Fenton Susan H, Ciminello Cassandra, Mays Vickie M, Stanfill Mary H, Watzlaf Valerie
Department of Clinical & Health Informatics, McWilliams School of Biomedical Informatics, UTHealth Houston, Houston, TX 77030, United States.
University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
J Am Med Inform Assoc. 2025 Apr 1;32(4):675-681. doi: 10.1093/jamia/ocaf003.
The ICD-10-CM classification system contains more specificity than its predecessor ICD-9-CM. A stated reason for transitioning to ICD-10-CM was to increase the availability of detailed data. This study aims to determine whether the increased specificity contained in ICD-10-CM is utilized in the ambulatory care setting and inform an evidence-based approach to evaluate ICD-11 content for implementation planning in the United States.
Diagnosis codes and text descriptions were extracted from a 25% random sample of the IQVIA Ambulatory EMR-US database for 2014 (ICD-9-CM, n = 14 327 155) and 2019 (ICD-10-CM, n = 13 062 900). Code utilization data was analyzed for the total and unique number of codes. Frequencies and tests of significance determined the percentage of available codes utilized and the unspecified code rates for both code sets in each year.
Only 44.6% of available ICD-10-CM codes were used compared to 91.5% of available ICD-9-CM codes. Of the total codes used, 14.5% ICD-9-CM codes were unspecified, while 33.3% ICD-10-CM codes were unspecified.
Even though greater detail is available, a 108.5% increase in using unspecified codes with ICD-10-CM was found. The utilization data analyzed in this study does not support a rationale for the large increase in the number of codes in ICD-10-CM. New technologies and methods are likely needed to fully utilize detailed classification systems.
These results help evaluate the content needed in the United States national ICD standard. This analysis of codes in the current ICD standard is important for ICD-11 evaluation, implementation, and use.
国际疾病分类第十次修订本临床修正版（ICD - 10 - CM）分类系统比其前身国际疾病分类第九次修订本临床修正版（ICD - 9 - CM）具有更高的特异性。向ICD - 10 - CM过渡的一个既定理由是增加详细数据的可用性。本研究旨在确定ICD - 10 - CM中更高的特异性在门诊护理环境中是否得到利用，并为基于证据的方法提供信息，以评估ICD - 11内容，用于美国的实施规划。
从IQVIA门诊电子病历 - 美国数据库2014年（ICD - 9 - CM，n = 14327155）和2019年（ICD - 10 - CM，n = 13062900）的25%随机样本中提取诊断代码和文本描述。对代码使用数据进行了代码总数和唯一代码数的分析。频率和显著性检验确定了每年两个代码集的可用代码使用率和未指定代码率。
与91.5%的可用ICD - 9 - CM代码相比，仅44.6%的可用ICD - 10 - CM代码被使用。在使用的总代码中，14.5%的ICD - 9 - CM代码未指定，而33.3%的ICD - 10 - CM代码未指定。
尽管有更详细的信息，但发现使用ICD - 10 - CM未指定代码的比例增加了108.5%。本研究分析的使用数据不支持ICD - 10 - CM中代码数量大幅增加的理由。可能需要新技术和方法来充分利用详细的分类系统。
这些结果有助于评估美国国家ICD标准所需的内容。对当前ICD标准中代码的这种分析对于ICD - 11的评估、实施和使用很重要。
